RESUMO
BACKGROUND: Drowning is still a major cause of accidental death worldwide. In 1997, Szpilman proposed a classification of drowning that has become the reference. As considerable efforts have been made to improve prevention and care, it seemed appropriate to reassess the prognosis and clinical presentation of drowning patients more than 20 years after this first publication. The aim of this study is to provide a reappraisal of patients who need advanced health care and a precise description of their respective neurologic, respiratory, and hemodynamic profiles. METHODS: This retrospective study was conducted over four consecutive summer periods between 2014 and 2017 in ICUs located in France, French Polynesia, and the French Antilles. Patients were classified according to the drowning classification system proposed by Szpilman. RESULTS: During the study period, 312 drowning patients were admitted with severe clinical presentation (grades 2-6). All patients benefited from rapid extraction from the water (< 10 min for all) and specialized care (emergency medical services), starting from the prehospital period. Although the global hospital mortality was similar to that previously reported (18.5%), great differences existed among the severity grades. Respective grade mortalities were low for grades 2 through 5 (grade 2, 0%; grade 3, 3%; grade 4, 0%; grade 5, 2%), and the mortality for grade 6 remained similar to that previously reported (54%). These results confirmed that the occurrence of cardiac arrest after drowning is still bad prognosis. Conversely, for other grades, this study strengthens the importance of specialized intervention to interrupt the drowning process. CONCLUSIONS: On the basis of these results, drowning-related cardiac arrest is still the prognosis cornerstone. For other victims, the prognosis was better than previously expected, which strengthens the importance of specialized intervention to interrupt the drowning process.
Assuntos
Afogamento/classificação , Adulto , Idoso , Afogamento/epidemiologia , Afogamento/mortalidade , Serviços Médicos de Emergência , Feminino , França/epidemiologia , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Afogamento Iminente/classificação , Afogamento Iminente/epidemiologia , Afogamento Iminente/terapia , Polinésia/epidemiologia , Prognóstico , Ressuscitação/métodos , Estudos Retrospectivos , Índias Ocidentais/epidemiologiaAssuntos
Afogamento Iminente/epidemiologia , Pneumonia , Humanos , Incidência , Martinica , Saúde Pública , Índias OcidentaisRESUMO
We read with great interest the recent paper by Cerland et al. on the frequency, nature, and consequences of post-drowning pneumonia[...].
Assuntos
Afogamento Iminente , Pneumonia , Humanos , Incidência , Martinica/epidemiologia , Saúde Pública , Índias OcidentaisRESUMO
Drowning represents one major cause of accidental death. Near-drowning patients are exposed to aspiration that may result in pneumonia with life-threatening consequences. We designed this descriptive study to investigate the frequency, nature, and consequences of post-drowning pneumonia. One hundred and forty-four near-drowning patients (33 children and 111 adults) admitted during four years to the University Hospital of Martinique, French Indies, were included. Patients presented pre-hospital cardiac arrest (41%) and exhibited acute respiratory failure (54%), cardiovascular failure (27%), and lactic acidosis (75%) on admission. Empirical antibiotics, as decided by the physicians in charge, were administered in 85 patients (59%). Post-drowning early onset bacterial pneumonia was diagnosed as "possible" in 13 patients (9%) and "confirmed" in 22 patients (15%). Tracheal aspiration revealed the presence of polymorphous pharyngeal flora (59%) or one predominant bacteria species (41%) including Enterobacter aerogenes, Enterobacter cloacae, Staphylococcus aureus, Pseudomonas aeruginosa, Aeromonas hydrophilia, and Morganella morgani. Despite adequate supportive care, drowning resulted in 45 fatalities (31%). Early onset bacterial aspiration pneumonia (either possible or confirmed) did not significantly influence the risk of death. In conclusion, near-drowning-related bacterial aspiration pneumonia seems rare and does not influence the mortality rate. There is still a need for practice standardization to improve diagnosis of post-drowning pneumonia and near-drowning patient management.
Assuntos
Antibacterianos/uso terapêutico , Afogamento Iminente/complicações , Pneumonia Aspirativa/tratamento farmacológico , Pneumonia Aspirativa/etiologia , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Afogamento Iminente/epidemiologia , Pneumonia Aspirativa/mortalidade , Índias Ocidentais , Adulto JovemRESUMO
To describe cerebral (structural and functional MRI) and neuropsychological long term changes in moderate drowning victim's compared to healthy volunteers in working memory and motor domains. We studied 15 adult drowning victim's in chronic stage (DV - out of 157 eligible cases of sea water rescues with moderate drowning classification) paired to 18 healthy controls (HC). All participants were investigated using intelligence, memory, and attention neuropsychological standard tests and underwent functional (motor and working memory tasks) and structural magnetic resonance imaging (MRI) in a 3 T system. All images were preprocessed for head movement correction and quantitative analysis was performed using FSL and freesurfer software packages. We found no between group differences in neuropsychological assessments. No MRI brain lesion was observed in patients, neither difference on morphometric parameters in any cortical or subcortical brain structure. In constrast, functional MRI revealed that patients showed increased brain response in the motor (left putamen and insula) and memory (left cuneus and lingual gyrus - not the classical memory network) tasks. Functional brain changes in motor and visual brain regions in victims of moderate drowning may indicate reduced brain reserve, despite the lack of structural and behavior alterations. More attention should be given to investigate ageing effects in this nonfatal drowning group.
Assuntos
Lesões Encefálicas/etiologia , Lesões Encefálicas/fisiopatologia , Encéfalo/fisiopatologia , Afogamento Iminente/complicações , Afogamento Iminente/fisiopatologia , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Lesões Encefálicas/psicologia , Mapeamento Encefálico , Feminino , Dedos/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Memória de Curto Prazo/fisiologia , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Afogamento Iminente/diagnóstico por imagem , Afogamento Iminente/psicologia , Vias Neurais/diagnóstico por imagem , Vias Neurais/patologia , Vias Neurais/fisiopatologia , Testes Neuropsicológicos , Tamanho do Órgão , Tempo de Reação , Adulto JovemRESUMO
BACKGROUND: Edwardsiella tarda is an Enterobacteriaceae found in aquatic environments. Extraintestinal infections caused by Edwardsiella tarda in humans are rare and occur in the presence of some risk factors. As far as we know, this is the first case of near-drowning-associated pneumonia with bacteremia caused by coinfection with methicillin-susceptible Staphylococcus aureus and Edwardsiella tarda in a healthy patient. CASE PRESENTATION: A 27-year-old previously healthy white man had an episode of fresh water drowning after acute alcohol consumption. Edwardsiella tarda and methicillin-sensitive Staphylococcus aureus were isolated in both tracheal aspirate cultures and blood cultures. CONCLUSION: This case shows that Edwardsiella tarda is an important pathogen in near drowning even in healthy individuals, and not only in the presence of risk factors, as previously known.
Assuntos
Bacteriemia/complicações , Coinfecção/microbiologia , Infecções por Enterobacteriaceae/complicações , Afogamento Iminente/complicações , Pneumonia/etiologia , Infecções Estafilocócicas/complicações , Adulto , Bacteriemia/tratamento farmacológico , Ceftriaxona/uso terapêutico , Ciprofloxacina/uso terapêutico , Clindamicina/uso terapêutico , Coinfecção/tratamento farmacológico , Edwardsiella tarda , Infecções por Enterobacteriaceae/tratamento farmacológico , Humanos , Masculino , Meticilina , Afogamento Iminente/microbiologia , Oxacilina/uso terapêutico , Pneumonia/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureusRESUMO
PURPOSE: The whole drowning process usually occurs within seconds to a few minutes. An early rescue may stop and/or prevent most medical complications. Fins, rescue tube, and rescue board (RB) are the equipment most frequently used by lifeguards. Our objective was to compare, in a water rescue quasiexperimental trial, these different pieces of rescue equipment to define the safest and with the lower rescue time as well as to assess their effects on the lifeguards' physiological state and cardiopulmonary resuscitation (CPR) performance. METHOD: A controlled trial was conducted to study the time effect of 4 different rescue techniques and assess CPR quality, along with the physiological effects of each rescue technique (blood lactate and subjective Borg's scale effort perception) on 35 lifeguards. RESULTS: Among the final sample subjects (n = 23), a total of 92 rescues were completed. Total water rescue time was longer without equipment (NE). The total rescue time was significantly lower using RB (P < .001). Similar good quality of CPR before and after water rescue was observed in all trials (P > .05), although correct ventilations represented less than 50% of total in all trials. Blood lactate increased after all rescues. The subjective effort Borg's scale showed significantly less effort using RB vs without equipment, fins, and fins and rescue tube. CONCLUSION: The use of propelling and/or floating equipment saves precious time with repercussions in the reduction of drowning mortality and morbidity. The RB offers a significant advantage. Lifeguards need more CPR training, especially considering the importance of efficient ventilations for drowning victims.
Assuntos
Reanimação Cardiopulmonar/instrumentação , Socorristas/estatística & dados numéricos , Equipamentos e Provisões , Afogamento Iminente/terapia , Esforço Físico/fisiologia , Trabalho de Resgate/métodos , Adulto , Índice de Massa Corporal , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/estatística & dados numéricos , Fadiga , Feminino , Humanos , Masculino , Manequins , Segurança , Espanha , Análise e Desempenho de Tarefas , Fatores de Tempo , Resultado do TratamentoRESUMO
INTRODUCTION: Submersion injury is associated with high morbidity and mortality, being the third leading cause of accidental death among children. OBJECTIVES: To analyze and describe risk factors, prognosis, and survival of victims, admitted to a third level Community Teaching Hospital. Population, material and methods. A retrospective, observational, analytical study. We studied patients admitted to the pediatric critical care unit, between 06/2000 and 01/2008. The following variables were analyzed: age, sex, length of stay, days of mechanical ventilation, Glasgow Coma Scale (GCS) score, apnea, bradycardia; baseline, 24 and 48 h lactacidemia, submersion time, swimming pool watchers of the victims. Stata 8.0 software was used; continuous variables were analyzed using Wilcoxon test; for categorical variables Z test and Chi square test were used, and a logistic regression analysis was performed. RESULTS: 30 near-drowning victims were admitted, median age was 25 months (R = 11-144 months). 41.3% occurred during summer, 60% were under parental supervision. Sibling supervision was associated with an increased risk of near-drowning (RR: 2.1; 95% CI 1.1-3.2). Immersion time was > 10 minutes in 3.4%; 26% had apnea, and the GCS score was < 5 in 19.99%. Lactic acid at admission was > 3 mmol/l in 10 patients. Risk factors like glucose level > or = 300 mg% (OR: 3.325), apnea (OR: 2.752), bradycardia (OR: 4.74), GCS <5 (OR: 3.550) and inmersion time > 10 minutes (OR: 5.12), were associated with poor prognosis. Mortality was 2/30 patients. CONCLUSION: In our population, the presence of apnea, bradycardia, GCS <5, glucose level > or = 300 mg%, submersion time > 10 minutes, and lactic acid > 6 mmol/l at admission and the first 24 h, were associated with a poor prognosis and serious injury.
Assuntos
Afogamento Iminente/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
Introducción. El ahogamiento por sumersión es un cuadro con alta morbimortalidad; es la tercera causa accidental de muerte en la población infantil. El objetivo fue analizar y describir factores de riesgo, pronóstico y supervivencia de las víctimas por casi ahogamiento, admitidas en un hospital universitario de alta complejidad. Población, material y métodos. Estudio retrospectivo, observacional, analítico. Se estudiaron los pacientes admitidos en una Unidad de Cuidados Intensivos Pediátricos, entre junio del año 2000 y enero de 2008. Se analizaron múltiples variables. Resultados. Ingresaron 30 pacientes, cuya mediana de edad fue 25 meses (intervalo: 11-144 meses), predominio masculino. El 41,3 por ciento de los episodios ocurrieron en verano, 60 por ciento de los niños estaba bajo supervisión de los padres. El tiempo medio de sumersión fue > 10 minutos en el 3,4 por ciento, tuvieron apnea al ingreso 26 por ciento y el Puntaje de Glasgow fue < 5 en 19,99 por ciento. El ácido láctico fue mayor a 3 mmol/l en 10 pacientes. Se asociaron con mal pronóstico, quienes al ingreso tuvieron glucemia ≥ 300 mg por ciento (OR: 3,325), apnea (OR: 2,752), bradicardia (OR: 4,74), Glasgow < 5 (OR: 3,550) y tiempo de sumersión > a 10 minutos (OR: 5,12). Murieron 2/30 pacientes. Conclusión. En nuestra población, la presencia de apneas, bradicardia, glucemia ≥ 300 mg por ciento, Puntaje de Glasgow < 5 y sumersión mayor a 10minutos, se asociaron a mal pronóstico. La elevación de ácido láctico > 6 mmol/l al ingreso y a las 24 h fue marcador de lesión grave.
Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Afogamento Iminente/complicações , Afogamento Iminente/epidemiologia , Prognóstico , Fatores de Risco , Interpretação Estatística de Dados , Análise de Sobrevida , Modelos Teóricos , Estudos Observacionais como Assunto , Estudos RetrospectivosRESUMO
Introducción. El ahogamiento por sumersión es un cuadro con alta morbimortalidad; es la tercera causa accidental de muerte en la población infantil. El objetivo fue analizar y describir factores de riesgo, pronóstico y supervivencia de las víctimas por casi ahogamiento, admitidas en un hospital universitario de alta complejidad. Población, material y métodos. Estudio retrospectivo, observacional, analítico. Se estudiaron los pacientes admitidos en una Unidad de Cuidados Intensivos Pediátricos, entre junio del año 2000 y enero de 2008. Se analizaron múltiples variables. Resultados. Ingresaron 30 pacientes, cuya mediana de edad fue 25 meses (intervalo: 11-144 meses), predominio masculino. El 41,3 por ciento de los episodios ocurrieron en verano, 60 por ciento de los niños estaba bajo supervisión de los padres. El tiempo medio de sumersión fue > 10 minutos en el 3,4 por ciento, tuvieron apnea al ingreso 26 por ciento y el Puntaje de Glasgow fue < 5 en 19,99 por ciento. El ácido láctico fue mayor a 3 mmol/l en 10 pacientes. Se asociaron con mal pronóstico, quienes al ingreso tuvieron glucemia ≥ 300 mg por ciento (OR: 3,325), apnea (OR: 2,752), bradicardia (OR: 4,74), Glasgow < 5 (OR: 3,550) y tiempo de sumersión > a 10 minutos (OR: 5,12). Murieron 2/30 pacientes. Conclusión. En nuestra población, la presencia de apneas, bradicardia, glucemia ≥ 300 mg por ciento, Puntaje de Glasgow < 5 y sumersión mayor a 10minutos, se asociaron a mal pronóstico. La elevación de ácido láctico > 6 mmol/l al ingreso y a las 24 h fue marcador de lesión grave.(AU)
Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Afogamento Iminente/epidemiologia , Fatores de Risco , Prognóstico , Análise de Sobrevida , Afogamento Iminente/complicações , Interpretação Estatística de Dados , Estudos Retrospectivos , Estudos Observacionais como AssuntoRESUMO
In two children with near drowning hypoxic encephalopathy and normal-appearing structural MRI, acute proton magnetic resonance spectroscopy ((1)H MRS) showed biochemical alterations that correctly indicated prognosis and helped to guide management decisions. Elevation of the lipid-lactate and glutamine-glutamate peaks, on the early (72 hour) (1)H MRS, predicts a poor prognosis. Absence of lipid-lactate and glutamine-glutamate peaks on the early (1)H MRS and reversibility of early mild metabolite abnormalities on follow up examination relates with good outcome.
Assuntos
Ácido Glutâmico/metabolismo , Glutamina/metabolismo , Hipóxia-Isquemia Encefálica/metabolismo , Ácido Láctico/metabolismo , Espectroscopia de Ressonância Magnética/métodos , Afogamento Iminente/metabolismo , Criança , Pré-Escolar , Feminino , Humanos , Hipóxia-Isquemia Encefálica/diagnóstico , Metabolismo dos Lipídeos , Masculino , Afogamento Iminente/diagnóstico , Prognóstico , PrótonsRESUMO
In two children with near drowning hypoxic encephalopathy and normal-appearing structural MRI, acute proton magnetic resonance spectroscopy (¹H MRS) showed biochemical alterations that correctly indicated prognosis and helped to guide management decisions. Elevation of the lipid-lactate and glutamine-glutamate peaks, on the early (72 hour) ¹H MRS, predicts a poor prognosis. Absence of lipid-lactate and glutamine-glutamate peaks on the early ¹H MRS and reversibility of early mild metabolite abnormalities on follow up examination relates with good outcome.
Em duas criancas vítimas de quase-afogamento com encefalopatia hipóxico-isquêmica, que apresentaram ressonância magnética por imagem normal, a espectroscopia de prótons por ressonância magnética (¹H MRS) na fase aguda mostrou alterações bioquímicas que corretamente indicaram o prognóstico e ajudaram a guiar o manejo terapêutico. Elevação dos picos de lipídeo-lactato e glutamina-glutamato na ¹H MRS precoce realizada com 72 horas previu um mau prognóstico. Relacionaram-se com bom prognóstico; a ausência dos picos de lipídeo-lactato e glutamina-glutamato na ¹H MRS precoce, e a reversibilidade no exame de controle (3 meses) das discretas anormalidades metabólicas encontradas no primeiro exame.
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Criança , Pré-Escolar , Feminino , Humanos , Masculino , Ácido Glutâmico/metabolismo , Glutamina/metabolismo , Hipóxia-Isquemia Encefálica/metabolismo , Ácido Láctico/metabolismo , Espectroscopia de Ressonância Magnética/métodos , Afogamento Iminente/metabolismo , Hipóxia-Isquemia Encefálica/diagnóstico , Metabolismo dos Lipídeos , Afogamento Iminente/diagnóstico , Prognóstico , PrótonsAssuntos
Vértebras Cervicais , Deslocamento do Disco Intervertebral/complicações , Afogamento Iminente/etiologia , Compressão da Medula Espinal/complicações , Humanos , Deslocamento do Disco Intervertebral/diagnóstico , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Pessoa de Meia-Idade , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/cirurgiaAssuntos
Desfibriladores/história , Ressuscitação/história , Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Inglaterra , Historiografia , História do Século XVIII , Humanos , Caixas de Remédio/história , Afogamento Iminente/história , Afogamento Iminente/terapia , Ressuscitação/instrumentaçãoRESUMO
OBJECTIVES: At present, there is no reliable information indicating the best option of rescuing a non-breathing drowning victim in the water. Our objectives were to compare the outcomes of performing immediate in-water resuscitation (IWR) or delaying resuscitation until the victim is brought to shore. MATERIAL AND METHODS: A retrospective data analysis was conducted of non-breathing drowning victims rescued by lifeguards in the coastal area of Rio de Janeiro, Brazil. Patients were coded as IWR and no-IWR (NIWR) cases based on the lifeguard's decision whether to perform IWR. Death and development of severe neurological damage (SND) were considered poor outcome. RESULTS: Forty-six patients were studied. Their median age was 17 (9-31) years. Nineteen (41.3%) patients received IWR and 27 (58.7%) did not. The mortality rate was lower for IWR cases (15.8% versus 85.2%, P < 0.001). However, among surviving IWR cases, 6 (31.6%) developed SND. In multivariate analysis, higher age [odds ratio (OR) = 1.12 (95% confidence interval (CI) = 1.01-1.24), P = 0.038] was associated with death, while IWR [ OR = 0.05 (95% CI = 0.01-0.50), P = 0.011] was protective. When death or the development of SND was set as the dependent variable, longer cardiopulmonary arrest (CPA) duration was the unique variable selected (OR = 1.77 (95% CI = 1.13-2.79), P = 0.013]. Every patient with CPA duration higher than 14 min had a poor outcome. CONCLUSIONS: Delaying resuscitation efforts were associated with a worse outcome for non-breathing drowning victims. In the cases studied, IWR was associated with improvement of the likelihood of survival. An algorithm was developed for its indications and to avoid unnecessary risks to both victim and rescuer.
Assuntos
Afogamento Iminente/terapia , Ressuscitação/métodos , Adolescente , Adulto , Fatores Etários , Algoritmos , Criança , Feminino , Humanos , Hipóxia Encefálica/etiologia , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
AIMS: To report the case of a 26 year old white man, who developed chronic meningitis and intracerebral granulomata 15 days after an episode of near drowning in a swamp. METHODS: Aspergillus fumigatus was isolated from cerebrospinal fluid cultures. RESULTS: The patient died 70 days after the symptoms were first noticed, and seven days after a subarachnoid haemorrhage. Aspergillus has never been reported before as a cause of intracranial infection after near drowning. CONCLUSIONS: Physicians must be aware of this possibility when confronted with such a situation, because there are now effective therapeutic options for systemic aspergillosis.
Assuntos
Aspergilose/diagnóstico , Aspergillus fumigatus/isolamento & purificação , Meningite Fúngica/diagnóstico , Afogamento Iminente/complicações , Adulto , Aspergilose/etiologia , Evolução Fatal , Humanos , Masculino , Meningite Fúngica/etiologiaRESUMO
This report describes a fatal case of central nervous system pseudallescheriasis. A 32 year old white man presented with headache and meningismus 15 days after nearly drowning in a swine sewage reservoir. Computerised tomography and magnetic resonance imaging of the head revealed multiple brain granulomata, which vanished when steroid and broad spectrum antimicrobial and antifungal agents, in addition to dexamethasone, were started. Cerebrospinal fluid analysis disclosed a neutrophilic meningitis. Treatment with antibiotics and amphotericin B, together with fluconazole and later itraconazole, was ineffective. Miconazole was added through an Ommaya reservoir, but was insufficient to halt the infection. Pseudallescheria boydii was finally isolated and identified in cerebrospinal fluid cultures, a few days before death, three and a half months after the symptoms began. Diagnosis was delayed because of a reduction in the lesions after partial treatment, which prevented a stereotactic biopsy. Physicians should be aware of this condition, and provide prompt stereotactic biopsy. Confirmed cases should perhaps be treated with voriconazole, probably the most effective, currently available treatment for this agent.
Assuntos
Meningite Fúngica/diagnóstico , Micetoma/diagnóstico , Afogamento Iminente/complicações , Scedosporium/isolamento & purificação , Adulto , Fatores de Confusão Epidemiológicos , Evolução Fatal , Humanos , Masculino , Meningite Fúngica/tratamento farmacológico , Micetoma/tratamento farmacológicoRESUMO
OBJECTIVE: Drowning is the second leading cause of accidental death in the U.S.A., with near drowning accounting for a significant proportion of morbidity. In Barbados, there has been an increase in incidence of near drowning. The objective of this study was to document data for the Barbadian population. METHODS: The records of patients age 0-16 years who were admitted to the Queen Elizabeth Hospital during the period 1990-1996 were reviewed. Information on cases of drowning for the same period and age groups was obtained from the Coroner's Office. RESULTS: During the 7-year period of study, there was 27 near drowning and 19 drownings. The peak ages in both series were 11-16 years (adolescents). The male to female ratio was 3:1. For the near drownings 87 percent occurred in salt water. CONCLUSIONS: The peak incidence occurred during the summer months, June-Sept. However, no correlation between sea currents and tides could be made within the scope of this study. There was no documented evidence of any neurological deficit in the 24 cases of near drowning that were examined.(AU)
Assuntos
Criança , Pré-Escolar , Lactente , Feminino , Humanos , Masculino , Recém-Nascido , Afogamento/epidemiologia , Afogamento Iminente/epidemiologia , Barbados/epidemiologia , Estudos RetrospectivosRESUMO
Presentamos tres niños con sepsis precoz luego de episodios de sumersión,dos de ellos con desenlace fatal.En dos de los niños encontramos como agente etiológico Streptococcus pneumomiae,siendo ésta la primera comunicación en la literatura nacional de este germen como responsable de este tipo de infecciones.Revisamos la bibliografía y consideramos las opiniones de los expertos